Socioeconomic impact of diabetic nephropathy: can we improve the outcome?

The prevalence of non-insulin-dependent diabetes mellitus-associated nephropathy is increasing worldwide. Obviously, a greater commitment of time is required from health providers to care for such patients. Moreover, when these patients develop end-stage renal disease, healthcare costs increase geometrically when viewed in the total context of lost wages and increased health-care expenditures.

Strict control of glucose as well as a low-protein and low-salt diet are important, but ultimately, aggressive blood pressure reduction is required to markedly decrease the time to dialysis.

Angiotensin converting enzyme (ACE) inhibitors should be part of the blood pressure-lowering therapy in all such patients. Recent data support the concept that addition of an ACE inhibitor to other blood pressure-lowering regimens delays the time to dialysis. Moreover, non-dihydropyridine calcium channel blockers should also be added for blood pressure control in these patients.

Recent evidence from long-term studies in patients with nephropathy from non-insulin-dependent diabetes suggest that this subclass of calcium blockers is similar in efficacy to ACE inhibitors.

The use of these strategies to reduce arterial systolic/diastolic pressure to < 130/80 mmHg will provide long-term benefit both to the patient and to society.